BMA outlines alternative approach to reform

In a discussion paper entitled Arational way forward for the NHS in England, which outlines an alternative approach to health reform, the BMA suggests a system that would separate national politics from the day-to-day running of the health service.

Under the system, the NHS constitution would contain the core values of the NHS, incorporating new ones such as supporting education and research alongside the founding values. It would include a charter explaining what the public can expect as patients and carers and what the NHS expects from them. Crucially it would also contain arrangements to determine the range of services that are nationally available on the NHS, together with nationally-agreed standards for the quality of those services.

James Johnson, chairman of the BMA, said: “The BMA believes that the NHS should provide a comprehensive range of services, available to all on an equal footing. If we are going to retain an equitable, universal approach within limited resources then priority setting is inevitable.

Politicians need to acknowledge this, and that it happens already but in a non-transparent and piecemeal fashion. A clear and transparent approach is needed.

“We need a public debate to decide a process to define a list of core NHS services – it will be a very substantial core – that will be nationally available. We need an ongoing mechanism to review and amend priorities in the NHS which must include an effective way of incorporating the views of patients, public and professionals.”

Under the BMA’s proposals, Parliament would establish and appoint the NHS Board of Governors. The Board would be responsible for ensuring compliance with the NHS Constitution and be accountable to Parliament. An executive management board would guide the performance and national operation of the NHS.

James Johnson added: “As the ultimate guardians of the public purse, politicians and Parliament should decide the high-order questions around setting priorities and funding. When it comes to the day-to-day running of the NHS, the role of national politics should be significantly reduced. The time has come to look at a much more independent framework for the NHS to allow greater flexibilities for health economies to develop care systems and to find ways of increasing local accountability.”